ROTATION INFORMATION
DEPARTMENT OF ANESTHESIA
RESIDENCY TRAINING PROGRAM
UNIVERSITY OF MANITOBA
ANESTHESIA RESIDENT ROTATION
CARDIOLOGY
INTRODUCTION
The competent anesthesiologist is a perioperative physician. The provision of complete
perioperative care includes the management of cardiovascular disease in the entire
perioperative period. Whether investigating and optimizing pre-existing disease and
cardiovascular risk, or managing of cardiovascular complications, a current and thorough
understanding of the standards of cardiovascular care is required. Along with the BCT
year and other Internal Medicine and Subspecialty rotations, this Cardiology rotation is
designed to allow the resident to acquire both general medical knowledge, and specialty
specific knowledge, necessary to function as a competent perioperative physician.
GOALS AND OBJECTIVES
The University of Manitoba Training Program for Residents in Anesthesia has been
developed in accordance with the guidelines of the Royal College of Physicians and
Surgeons of Canada.
The following Rotation Specific Goals and Objectives for Cardiology, provide specialty
specific emphasis to particular components of the general Program Goals and Objectives.
Please refer also to the National Curriculum for Canadian Anesthesia Residency for more
information on expected knowledge and skills.
All appropriate Program Goals and Objectives also apply to this rotation.
1. Medical Expert/Clinical Decision Maker
By the end of this rotation, the resident will be able to perform the following:
A. Diagnosis and treat the following common cardiac lesions that occur in adult
patients, providing a rationale for care plans based upon a thorough
understanding of the pathophysiology:
i. Coronary artery disease
a. Atherosclerotic
b. Vasospastic
ii. Valvular heart disease
a. Aortic
b. Mitral
c. Tricuspid
d. Pulmonic
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B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
iii. Congestive Heart Failure
iv. Cardiomyopathies
v. Hypertensive Heart Disease
vi. Common Atrial and Ventricular Arrhythmias
vii. Endocarditis
viii. Disease of the Thoracic Aorta
a. Aneurysm
b. Dissection
c. Traumatic rupture
ix. Disease of the Pericardium
a. Tamponade (acute and chronic)
b. Constriction
c. Pericarditis
x. Congenital Heart Disease in the Adult
Apply an organized method of assessment of patients with cardiac disease and
communicate a succinct evaluation and management plan to Attending Staff.
Formulate and implement an appropriate plan for patient management and
provide a rationale based on understanding of the cardiac problem, coexisting
problems, and patient factors such as anxiety, discomfort, culture, language,
ethnicity, age, and gender
Identify the appropriate indications, contraindications, advantages and
limitations of angiographic, catheterization, echocardiographic, and nuclear
imaging tests
Interpret the information from these tests.
Interpret a standard ECG.
Identify the indications for and interpret a stress test ECG.
Assess and optimize patients presenting with cardiac disease for cardiac and
non-cardiac surgery.
Manage patients who present with pacemakers and implantible defibrillators.
Identify the indications for and implement temporary cardiac pacing.
Identify the indications for a coordinate access to permanent cardiac pacing.
Manage patients with an orthotopic heart transplant, taking into account all
anesthetic implications and pathophysiology.
Correctly prescribe and administer the following, and provide a rationale
based on the indications, contraindicitions, relative differences between
choices
i. Antiarrythmics
ii. Antihypertensives (IV and oral, emergency and ambulatory)
iii. Vasodilators
iv. Inotropes
v. Antianginals
vi. anticoagulants and antiplatelet agents
vii. other therapies such as cardioversion and pacemakers.
2. Communicator
By the end of this rotation the resident will be able to:
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A. Establish a therapeutic relationship with cardiac patients emphasizing
understanding, trust, empathy, and confidentiality
B. Elicit and synthesize relevant information from the patient and/or family, and
be able to assess and take into account, the impact of a patient's age, gender,
ethnocultural background, social supports, and emotional influences on
cardiac illness
C. Discuss appropriate information with the patient, his/her family to facilitate
the optimal management plan for the care of the patient
D. Obtain complete informed consent for all treatments and procedures
3. Collaborator
By the end of this rotation, the resident will be able to perform the following:
A. Communicate a succinct assessment and management plan to Attending Staff
and to other physicians requesting consultation.
B. Effectively consult with other physicians and health care professionals and
demonstrate appropriate judgment regarding the assessment of cardiac disease
C. Coordinate the care of cardiac patients with other members of the care team,
especially cardiologists, surgeons, or other physicians requesting consultation,
and nurses, as well as staff in the intensive care unit, ward, step-down unit,
and in off-site locations such as the cardiac catheterization laboratory
D. Manage urgent and crisis situations such as hemodynamic instability or
cardiac arrhythmia, as a team member or leader
a. Manager
By the end of this rotation, the resident will be able to perform the following:
E. Manage time and assign priorities for:
i. Efficient use of time for patient assessment
ii. Changes in response to emergencies
F. Make treatment plans that take into account cost-effective use of medical
resources such as drug or other therapeutic choices
4. Health Advocate
By the end of this rotation, the resident will be able to perform the following:
A. Recognize and explain the importance of broad health and societal issues with
impact on the care of the patient with cardiac disease including:
i. Risk factors and demographics which contribute to the development
of cardiovascular disease
ii. Lifestyle changes and programs which aid in the prevention of
cardiovascular disease
iii. Factors that identify high-risk patients
iv. Short-term and long-term programs for postoperative health
maintenance
5. Intervene on behalf of patients regarding their care and safety
6. Scholar
By the end of this rotation, the resident will be able to perform the following:
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A. Develop, implement, and monitor a personal continuing education strategy
B. Formulate questions for ongoing appraisal
C. Search and critically appraise current cardiology literature, and apply new
knowledge based on appropriate evidence
D. Demonstrate effective oral presentation of case reports, journal club, or rounds
with sound synthesis of pertinent information
E. Facilitate learning of patients, housestaff, students and other professionals
7. Professional
Throughout this rotation, the resident shall:
A.
B.
C.
D.
E.
Deliver highest quality care with integrity, honesty, and compassion
Demonstrate appropriate interpersonal and professional behavior
Practice medicine ethically consistent with the obligations of a physician
Be aware of the ethical and legal aspects of patient care
Show recognition of personal limits through appropriate consultation (with
staff supervisors, other physicians, and other health professionals) and show
appropriate respect for those consulted
F. Demonstrate including the patient in discussions of care management
G. Recognize potential conflict in patient care situations, professional
relationships, and value systems, and demonstrate the ability to discuss and
resolve differences of opinion. Additionally, be able to accept constructive
feedback and criticism and implement appropriate advice
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